An observational study of older patients' participation in hospital admission and discharge - exploring patient and next of kin perspectives
An observational study of older patients' participation in hospital admission and discharge - exploring patient and next of kin perspectives
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DOI：
10.1111/jocn.12773
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发表时间：
2015-06-01
影响因子：
4.2
通讯作者：
Storm, Marianne
中科院分区：
文献类型：
--
作者：
Dyrstad, Dagrunn N.;Laugaland, Kristin A.;Storm, Marianne
目的和目的探讨老年患者在入院和出院时的参与情况。背景建议将患者参与作为提高过渡时期医疗质量的手段。有慢性病、肢体残疾和认知障碍的老年人经常需要从初级卫生保健转到医院卫生保健，反之亦然。设计采用参与式观察性研究设计。方法对挪威两家医院(2012年)入院和出院的41名老年患者(75岁以上)进行参与性观察。观察包括与患者及其近亲的简短对话，以记录他们的参与经历。结果医护人员与患者之间的信息交流程度不同，患者在入院和出院时缺乏决策参与，患者及其亲属观察和体验到了这两种情况。近亲似乎是患者入院时的重要倡导者，并在入院和出院期间提供实际支持。数据表明，患者参与入院和出院受到时间限制和医疗保健专业人员繁重工作量的影响。患者的健康状况和偏好也会影响老年患者的参与。结论老年患者在入院和出院期间的参与受到多个问题的影响。老年患者的参与需要卫生保健专业人员的持续支持，他们既承认患者的个人偏好，也承认他们的参与能力。与临床实践的关系研究结果报告了老年人及其近亲参与的差异。有必要增加和支持老年患者参与住院和出院。
Aims and objectivesTo explore older patients' participation during hospital admission and discharge.BackgroundPatient participation is suggested as a means to improve the quality of transitional healthcare. Older people with chronic diseases, physical disabilities and cognitive impairments often need to transfer from primary to hospital healthcare and vice versa.DesignThis study adopts a participant observational research design.MethodsParticipant observations of 41 older patients (over 75years of age) during hospital admission and discharge were conducted in two hospitals in Norway (in 2012). The observations included short conversations with the patient and their next of kin to capture their participation experiences. Systematic text condensation was used to analyse the data material from the field notes.ResultsVarying degrees of information exchange between healthcare professionals and patients, and a lack of involvement of the patient in decision-making (in admission and discharge) were observed and experienced by patients and their next of kin. The next of kin appeared to be important advocates for the patients in admission and provided practical support both during admission and discharge. Data suggest that patient participation in admission and discharge is influenced by time constraints and the heavy workloads of healthcare professionals. Patients' health conditions and preferences also influence participation.ConclusionsSeveral issues influence the participation of the older patients during hospital admission and discharge. Participation of the older patients needs continuous support from healthcare professionals that acknowledges both the individual patient's preferences and their capacity to participate.Relevance to clinical practiceStudy findings report discrepancies in the involvement of older people and their next of kin. There is a need to increase and support older patients' participation in hospital admission and discharge.